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� �RMIT APPLICATIC J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br />SITE A�DRESS �/� ��(�,n�,�y�Nj J� I/�11A . I <br />�� r�uuU��� I�I�IIW <br />i cr.nTNO. i� �_ BLOCK TRACT <br />DESC. <br />TENANTNAME <br />CONTRACTOR �,r,�,,,,t,Q. <br />CONTR. LlCEN E il I' <br />�i �i�1� <br />USE OF BUILDING <br />WORK D SCF� R�PT��N � �� <br />. <br />eL l.b�JL�J <br />N0. I TYPE OF FI%NRE OR ITEM <br />� Tailet <br />�Bathluh <br />Levetory (wesh besin) <br />I. Fhorrer <br />_�I IC+!-he� sink 8 disposal <br />_L DIShWfi6liBf <br />clotnes wesfier <br />Leundry trey <br />Sink (servicelberlmopletc.) <br />� Beckflow preventer <br />y Urinal <br />Drinking Fountein <br />Floor draln <br />Grease trep <br />Root drelns <br />Other <br />PARCEL TAX I.D. N <br />�iC/E 1/oz <br />ICONTACT ��R PERMIT <br />�l�l�_'�2lrt �/Q/' heJ <br />PERMIT il <br />; ��G:a i,'J <br />PHONE <br />.�� .. <br />CITYRIP PHON <br />� gDDRE95 . /�`_ � <br />f ~ 9�� 5`.��(/�"`'/oZ, �iz,��'�t/�a' <br />HEAT SOURCE <br />Electnc �es _ Other <br />• /5�70 <br />,GUA- <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinp unils <br />1, Forcad air systems <br />Ges piping <br />r � Wa1er heater <br />1 Ges fireplace <br />L Gesrange <br />1 Clolhes dryer <br />�L Range hood <br />�xhauet 1en <br />Heal pump <br />UNl hea�er <br />" 8oilar <br />� Reitigeralion <br />Woodstave <br />Other�— <br />CITY C�F EVERE� S T� CODE IS J106 <br />I hereby cerilify lhet I heve reed end examiner, this epplicelion end know the seme to be true and correct. All ptovislona ollews end <br />ordinaces goveming this type of work wil�l be comPlied � th whather spadfied hereln or not. The grenUng of e��o���� 1 P�'h the <br />to give eulhority to violate or cencel Ihe ravislon ol en ofher stele or locel law reguleUng construction o� the pe <br />conslrudlon. Thet I em euthorized by the owner o11hls property to perform ihe vrork tor whlch applicetion is mede end I comply <br />Stete Conqectars Lew 18.27 RCW and 296.200 WAC. � <br />